title: Early clean intermittent catheterization may not prevent dimercaptosuccinic acid renal scan abnormalities in children with spinal dysraphism.
abstract: OBJECTIVE
  To determine whether early initiation of clean intermittent catheterization is associated with increased renal preservation in children with spinal dysraphism based on dimercaptosuccinic acid (DMSA) renal scans.
  
  
  METHODS
  A retrospective review was performed of 100 patients from a pediatric spinal defects clinic from June 2007 to October 2011 who were followed with routine studies including DMSA scans, voiding cystourethrograms, renal/bladder ultrasounds, and urodynamics. DMSA scans were reviewed for evidence of renal cortical loss as defined by presence of scarring or difference in differential function greater than 15%. Multivariate analysis was performed for risk factors for upper tract damage.
  
  
  RESULTS
  Renal cortical loss on DMSA scan was found in 43/100 (43%) of patients. CIC was started at birth in 17/100 (17%) of patients with the rest starting at a median age of 5 years (IQR 3-9). Upon multivariate regression analysis, age at DMSA scan (OR 1.21; 95% CI 1.08-1.36), history of VUR (OR 8.64; 95% CI 2.52-29.57), history of hydronephrosis (OR 3.44; 95% CI 1.12-10.5), and CIC from birth (OR 9.26; 95% CI 1.99-43.18) were statistically significant predictors of kidney damage.
  
  
  CONCLUSIONS
  Early initiation of CIC may not reduce the incidence of DMSA abnormalities in pediatric patients with spinal dysraphism.
authors.affiliation: UC San Diego Health System, Department of Urology, 200 W Arbor Dr. #8897, San Diego, CA 92103-8897, USA. Electronic address: jaw020@ucsd.edu.
authors.forename: Jason
authors.initials: J
authors.lastname: Woo
authors.affiliation: UC San Diego Health System, Department of Urology, 200 W Arbor Dr. #8897, San Diego, CA 92103-8897, USA. Electronic address: klpalazzi@ucsd.edu.
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi
authors.affiliation: Rady Childrens Hospital, Department of Radiology, 7920 Frost Street, Suite 200, San Diego, CA 92123, USA. Electronic address: gkaplan@rchsd.org.
authors.forename: Jerry
authors.initials: J
authors.lastname: Dwek
authors.affiliation: UC San Diego Health System, Department of Urology, 200 W Arbor Dr. #8897, San Diego, CA 92103-8897, USA; Rady Childrens Hospital, Department of Urology, 7920 Frost Street, Suite 200, San Diego, CA 92123, USA. Electronic address: gkaplan@rchsd.org.
authors.forename: George
authors.initials: G
authors.lastname: Kaplan
authors.affiliation: UC San Diego Health System, Department of Urology, 200 W Arbor Dr. #8897, San Diego, CA 92103-8897, USA; Rady Childrens Hospital, Department of Urology, 7920 Frost Street, Suite 200, San Diego, CA 92123, USA. Electronic address: gchiang@rchsd.org.
authors.forename: George
authors.initials: G
authors.lastname: Chiang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000473:pathology; D015331:Cohort Studies; D016001:Confidence Intervals; D003558:Cystoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057928:Intermittent Urethral Catheterization / Q000379:methods*; D007677:Kidney Function Tests; D008297:Male; D015999:Multivariate Analysis; D011856:Radiographic Image Enhancement; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention / Q000379:methods; D012720:Severity of Illness Index; D016135:Spinal Dysraphism / Q000150:complications* / Q000175:diagnosis; D018709:Statistics, Nonparametric; D004113:Succimer; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014563:Urodynamics; D014567:Urography / Q000379:methods
chemical_list: D004113:Succimer
keywords: Clean intermittent catheterization; Dimercaptosuccinic acid; Myelodysplasia; Spina bifida